A study protocol for an mHealth, multi-centre randomized control trial to promote use of postpartum contraception amongst rural women in Punjab, Pakistan

Background: Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling.Methods: A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for their own use will be eligible to participate in this study. The participants will be randomly allocated to one of three study arms: a) voice and text messages; b) interactive telephone-based counselling; or c) control arm (no additional phone-based support). The intervention counselling module will be developed based on the Integrated Behaviour Model which was recently adapted, and tested for the family planning context in Pakistan. It will broadly cover birth-preparedness, importance of birth spacing, and postnatal care. The phone-based intervention aims to improve women\u27s ability to use contraception by providing them with information about a range of methods, access to family planning methods through outlets such as Suraj SF providers, connecting them with MSS field health educators to help them reach the centres, motivation by re-enforcing the benefits of contraceptive use on women\u27s quality of life, and dispelling myths and misconceptions about modern contraceptive methods. Risk differences will be used as the measure of effect of the intervention on the outcomes.Discussion: The study findings will highlight effectiveness of mobile phone in raising awareness of maternal health and contraception, which in turn, is expected to be translated into increased proportion of: at least four antenatal visits, skilled birth or institutional delivery, postpartum contraceptive use, postnatal check-up, child immunization, and breastfeeding. Moreover, if the text and voice messages approach is proven to be non-inferior to interactive calls, it will provide evidence to making promotion of healthcare less resource intensive, and thereby contribute in improving the efficiency of the healthcare system.Trial registration: This trial was prospectively registered with the Clinical Trials registry ( NCT03612518 ) on August 2nd, 2018

Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks

Objective: To assess the outcome of Endonasal Endoscopic Repair of Cerebrospinal Fluid LeaksMethods and Materials: This study was conducted from July 2013 to October 2014 at the department of Neurosurgery, PGMI, Lahore General Hospital, Lahore. A total of 20 patients were included in this study of both gender (male and female) and in the age range of 15 – 65 years. All the patients undergone Endonasal Endoscopic with the use of a Karl Stortz rigid endoscope of 0º and 30º with a 4mm diameter. All of them were followed up for recurrence of CSF leak and any postoperative complication.Results: Out of 20 patients, there were 08 (40%) males and 12 (60%) female patients. Their age ranged from 15 – 65 years. The maximum numbers of patients were in their third and fourth decade of life. The cause of CSF leak was spontaneous in 11(55%), iatrogenic in 5 (25%) and traumatic in 4 (20%) of cases. In 13 (65%) patients, CSF rhinorrhea was from right nostril and in 7 (35%) patients left side was affected. Endonasal Endoscopic CSF repair was done in all patients and was successful in 18 (90%) of patients. Two patients (10%) presented with recurrence of CSF leak in which one was successfully re-operated endoscopically and other undergone transcranial approach. Overall the success rate was 95% in our study. Only one patient complicates with meningitis postoperatively which was resolved with antibiotics.Conclusion: The repair of the CSF rhinorrhea by Endonasal Endoscopic surgery is minimal invasive, safe, effective and is a valid alternative to the cranial approach. Abbreviations: CSF: Cerebrospinal Fluid. MRI: Magnetic Resonance Imaging

Opinto-ohjauksen suunnitelman jalkauttaminen toiminnallisen menetelmän avulla

Artikkelissa tarkastellaan opinto-ohjaussuunnitelman jalkauttamista oppilaitosympäristössä tuoden esiin yhden näkökulman, kuinka jalkauttamista voidaan tehdä käytännössä henkilöstöä osallistaen. Jalkauttaminen liittyy yleisemmin organisaatioissa strategiseen johtamiseen sekä osaamisen kehittämiseen. Opinto-ohjaussuunnitelman jalkauttaminen tähtää opinto-ohjauksen laadun kehittämiseen oppilaitoksissa. Esimerkkitapauksena kuvataan Raahen koulutuskuntayhtymän ammatillisen 2. asteen oppilaitosten (nykyisin Koulutuskeskus Brahe) opinto-ohjauksen suunnitelman jalkauttamista toiminnallisen menetelmän avulla. Opinto-ohjaussuunnitelman jalkauttamisen idea oli tarjota toiminnallisen työskentelytavan avulla mahdollisuus kokea opinto-ohjaus opiskelijan näkökulmasta. Toiminnallisen toteutuksen ohjausteoreettinen viitekehys rakentuu ratkaisu- ja voimavarakeskeiselle sekä sosiodynaamiselle ohjausteorialle. Opinto-ohjausmallina käytetään opintopolkumallia. Työhyvinvointipäivän yhteydessä toteutettu jalkauttaminen toteutui suunnitellusti, osallistujat lähtivät innokkaasti mukaan toimintaan ja antoivat myönteistä palautetta päivän onnistumisesta. Toiminallisuus teki opinto-ohjauksen suunnitelmaan perehtymisestä kevyemmän ja konkreettisemman. Ammatillisen 2. asteen koulutuksen reformin lähtökohtana on siirtyä henkilökohtaistettuun osaamisperusteiseen oppimisprosessiin. Tämä edellyttää osaavan ja oikea-aikaisen ohjauksen ja tuen saatavuutta sekä koko opetus- ja ohjaushenkilöstön sitoutumista ohjaukselliseen ajatteluun ja toimintaan. Tässä valossa oppilaitosten ohjaussuunnitelmien jalkauttaminen nousee tärkeäksi tehtäväksi. Koska ohjaus kuuluu koko henkilöstölle, on oleellista osallistaa henkilöstö ohjauksen kehittämiseen jo suunnitelmien laadintavaiheissa

ANALYSIS OF CHINA’S FOREIGN POLICY OF BUILDING OF HARMONIOUS WORLD; RELEVANCE FOR PAKISTAN

China, a lofty nation of 5000 years of uninterrupted civilization, world’s second largest economy, a nation of huge land mass and vibrant 1.3 billion populations with permanent seat in United Nation’s Security Council is steadfast on the road of peaceful development. Despite foreign aggressions, humiliations and occupations, Chinese nation never demonstrated revengeful attitude and instead adopted a submissive and non- confrontational approach to buy time for national cohesion, economic and infrastructure development and making the country stronger. The consistent and rapid industrialization has enabled China to maintain over 9% growth rate which brought rich dividends for China and is now termed as economic super power and world’s manufacturing industry. This all can be attributed to consistent pragmatic foreign policy and unique blend of relevant to all and friend of all with mutual accommodation and peaceful coexistence. Pakistan and China are termed as Iron Brothers, therefore, Pakistan can accrue many dividends from rising status of China. This research article critically examines evolution of China’s foreign policy and draws relevance for Pakistan with suggested course of actions to make more dynamic and pragmatic foreign policy. The views and analysis expressed in this article are author’s own.</jats:p

The correlation and determinants of cost-benefit analysis of measles vaccines among the medical centers providing Expanded Program on Immunization (EPI)

Introduction: Measles is a highly contagious viral infection, vaccine-preventable diseases claim the lives of nearly 30 million people each year around the world, including 17% of children under the age of 5.&#x0D; Methodology: This was a descriptive and cross-sectional investigation. Retrospective data collection was used. We looked at medical centers that provided EPI administrations.&#x0D; Results: Around 8% of the youngsters in the study were found to have measles, according to the health center's records. There are an undetermined number of measles-infected children. Only 12% of those surveyed had received the measles vaccine, and the vast majority (88%) had never received the shot. According to statistical analysis, the study's r square value is r=0.35, which is considered to be an intermediate direct relationship (Wastage of vaccine and total cost). It illustrates that if there is no system of checks and balances on vaccine waste, it could have an impact on the overall cost of the vaccination. Vaccines wastage shows a positive association with Dose wastage x2= 438.8 (p-value 0.002). the breakage of vaccine vial x2 = 369.6 (p-value 0.015), expiration of vaccines x2 = 1068 (p-value 0.006), cold chain maintenance x2 = 79.99 (p-value 0.014) &amp; inventory missing was x2 646.9 (p-value 0.004) showed statistical significance.&#x0D; Conclusion: The elimination of any disease would be contributed by the parallel factors one of that includes also financial state. In less time and cost we can vaccinate the number of children and can achieve universal coverage of immunization.</jats:p

Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan

BACKGROUND: Musculoskeletal manifestations of diabetes in the upper limb are well recognized. No data has been available in this regard from Pakistan. Our aim was to find out the frequency of upper limb musculoskeletal abnormalities in diabetic patients. METHODS: This was an observational study in which type 2 diabetes patients attending our diabetic clinic were enrolled along with age and gender matched controls. Data was analyzed on SPSS 16. RESULTS: In total, 210 Type 2 diabetics (male 34.3%, female 65.7%) and 203 controls (male 35%, female 65%) were recruited. The mean age was 50.7± 10.2 years in diabetic group as compared to 49.5±10.6 years in the control group. The frequencies of hand region abnormalities were significantly higher in the diabetic subjects as compared to the controls (20.4%, p-value <0.001). Limited joint mobility (9.5% vs 2.5%), carpal tunnel syndrome (9% vs 2%), trigger finger (3.8% vs 0.5%), and dupuytren’s contracture (1% vs 0%) were found more frequent as compared to controls (all p-values <0.05). In the shoulder region of diabetic subjects, adhesive capsulitis and tendonitis was found in 10.9% and 9.5% respectively as compared to 2.5% and 2% in control group [p- value <0.001]. A weak but positive relationship was observed between age and duration of diabetes with these upper limb abnormalities. However, no correlation was found between the frequencies of these abnormalities with control of diabetes. CONCLUSION: A higher frequency of upper limb musculoskeletal abnormalities was observed in Type 2 diabetic patients as compared to control group